Regular Clinical Breast Examination Research Articles

Investigation of the Effect of Women's Breast Cancer Worry Levels on Breast Cancer Prevention Behavior.

The aim of this study was to investigate the extent of worry about breast cancer (BC) amongst a sample of women and to examine the effect of this on behavior to prevent BC. This cross-sectional study was conducted in 271 women aged 18 years and above who attended the Family Medicine Outpatient Clinic of a tertiary hospital and met the inclusion criteria. Data were collected using the following tools: Patient Information Form; Breast Cancer Worry Scale (BCWS); Breast Cancer Prevention Behaviors Identification Scale (BCPBIS); and Mammography Processes of Change Scale (MPCS). When evaluated according to BCWS scores (mean 8.43±3.36), the BC worry levels were found to be low. The behavior adopted for prevention was also found to be positive according to BCPBIS (mean 119±15.26) and MPCS (mean 82.38±12.81) scores. A significant correlation was found between the BCWS and both the BCPBIS and MPCS scores, and again between the BCPBIS and MPCS scores (p<0.001 for all). There was a correlation with three scale scores in those who had knowledge about BC, and those who had regular clinical breast examination (BE) (p<0.05 for all). The BCPBIS score was found to be higher in those aged between 41-65 years, those who had mammography, and performed p self-BE (p = 0.002; p<0.001; p<0.001, respectively). According to the MPCS score, mammography behaviors was found to be more positive in those who had regular gynecological examinations and those who had mammography (p = 0.08 and p = 0.011). The participants generally had low BC worry levels and had adopted positive behavior for prevention. Being informed about BC and screening and having regular BE increased BC worry. Those with high BC worry, those who had mammography before, those who had knowledge about BC and screening, and those who regularly performed BE showed more positive behaviors toward preventing BC.

Barriers to Using Breast Cancer Screening Methods Among Adult Females in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Introduction Breast cancer (BC) is one of the most common cancers worldwide and it considerably increases morbidity and mortality globally. Screening methods, such as self-examination, clinical examination, and mammography, can help in early detection and treatment, which will help in improving survival rates and reducing mortality. While regular screening of the breast is essential to detect the earliest stages of breast cancer, not all women adhere to regular breast screening. Methods A cross-sectional study was conducted in Jeddah, Saudi Arabia, between December 2021 to July 2022. using an online self-administered questionnaire. The total number of responses (n = 328), Data was analyzed using SPSS 25. Results In this study, out of the 328 respondents, 18.9% reported undergoing regular mammography, 14.3% reported having regular clinical breast examinations, and 38.1% reported practicing regular breast self-examinations.. In addition, the participants' most known warning signs of BC were a lump under their armpit (69.1%). the most perceived barrier to breast self-examination (BSE) was Doing a breast examination will make her worry about what is wrong with her breast (47%). whereas the most barrier to clinical breast examination (CBE) was embarrassment (45.9%). On the other hand, the main barriers that prevented women from having mammograms were embarrassment (36%) and pain (32.6%). Conclusion The most perceived barrier to BSE was women's concern, while embarrassment and painful procedures were significant barriers to performing mammography and CBE. Therefore, adult females in Jeddah need educational programs to improve their knowledge and increase public awareness of breast cancer screening for early detection.

The imaging findings and diagnostic value of radiology modalities to assess breast malignancy among women aged younger than 30 years.

Breast cancer mainly affects women aged >50 years; however, younger women may also have advanced breast cancer, so early detection is important. To collect and review the imaging findings of women aged <30 years with breast cancer to find better diagnostic approaches for the early diagnosis of breast cancer in young women. In this study, 45 patients aged <30 years with a diagnosis of breast cancer were evaluated. Imaging assessments were performed based on ultrasound, mammography, and magnetic resonance imaging (MRI) findings. Finally, the findings were compared with the pathological results. Predominant findings in ultrasound included irregular spiculated mass in 59.4%. In mammography, irregular high-density mass (46.5%) and suspicious micro calcification (42.8%) were the most common findings. In MRI, the predominant feature was a heterogeneous enhancing mass with an irregular shape and irregular margin (81%) with a 45% plateau and 36% washout kinetic pattern. In the pathology assessment, invasive ductal carcinoma was the most common finding (84.4%). All three modalities-MRI, ultrasonography, and mammography-are valuable, with sensitivities of 100%, 93.3%, and 90%, respectively. Ultrasound, mammography, and MRI are highly sensitive and accurate tools for detecting breast cancer lesions in young women. Regular clinical breast examination with breast self-examination, and in suspected cases, ultrasound as the first imaging modality followed by mammography and/or MRI are the preferred diagnostic approach.

Breast Cancer Screening in Semi-Rural Malaysia: Utilisation and Barriers.

Breast cancer (BC) is the commonest cancer in Malaysia. Delayed diagnosis is a significant cause of BC mortality in the country. Early diagnosis and screening are vital strategies in mortality reduction. This study assessed the level of utilisation and barriers for breast self-examination (BSE), clinical breast examination (CBE) and mammogram in a semi-rural population in Malaysia and compared these across the different ethnic groups. This cross-sectional study was conducted among women aged 40 years and above, embedded within a health and demographic surveillance site (HDSS) in Segamat, Malaysia. Trained data collectors collected data on screening and barriers during home visits. Study participants (n = 250) were aged 59.4 ± 10.9 years and represented Malaysia’s three major ethnic groups. Practice of regular BSE, CBE uptake (ever) and mammogram (ever) was 23.2%, 36% and 22.4%, respectively. Regular BSE practice was highest in the Malay ethnic group and least among the Chinese. Regular CBE was very low in all ethnic groups (<5%). Mammogram uptake was highest among Chinese (34.4%), followed by Indians (30.4%) and Malays (16.6%). After adjusting for other socio-demographic variables, Malay ethnicity was positively associated with regular BSE (adjusted OR = 5.26, 95% CI 2.05, 13.50) and negatively associated with having had a mammogram (adjusted OR = 0.3, 95% CI 0.15, 0.57). Lower education was negatively associated (adjusted OR = 0.36, 95% CI 0.17, 0.74) with mammogram attendance (ever). Emotional and financial barriers were the most reported types of barriers, specifically, fear of diagnosis (74.8%), cost of diagnosis (69.6%) and fear of losing a breast (66.4%). Malay women more commonly reported most barriers compared to other ethnic groups. Screening uptake was low among semi-rural women in Malaysia. Implementing culturally appropriate interventions that consider ethnic differences is crucial to empowering women to engage in BC screening initiatives in these communities.

The Relationship between Knowledge and Practice in Clinical Breast Examination among Women in Baghdad, Iraq

Aim: This study aims to determine both the level of knowledge, attitude, and practice in clinical breast examination in women and the relationship between knowledge and practice.Data collection was performed within a three-month period starting from February 2019 on. Subjects and Method: A cross-sectional analytical study included 657 non-randomly selected women visiting primary health care centers in Baghdad city with an average of age between (20-59) years old. Results: Only 51.8% ever heard of clinical breast examination. The mean knowledge score for clinical breast examination was (51.2±44). Only 5.5% of women performed regular clinical breast examinations. Participants who adequately practice clinical breast examination had a statistically significance higher mean score of knowledge than those without adequate clinical breast examination (100 vs 44.2), (P&lt;0.001). Conclusion: The study has concluded that practices of clinical breast examination were inadequate in the majority of participants and need to be improved by educational programs.

Accuracy of clinical breast examination’s abnormalities for breast cancer screening: cross-sectional study

ObjectivesThe guidelines for breast cancer screening with clinical breast examination (CBE) are diverging CBE is recommended in France, whereas it is not recommended in the United States and Canada, given the lack of clear benefit and the risk of overmedication. To assess the accuracy of abnormalities found during CBE for in breast cancer screening. Study designA cross-sectional study included women over 18 years with no history of breast cancer coming for a mammography at 3 ambulatory radiology practices in Paris. A questionnaire collected the risk of breast cancer on mammography according to the Breast Imaging-Reporting And Data System (Bi-RADS) (high risk: Bi-RADS 4 or 5 versus lower risk: other Bi-RADS categories), the risk factors for breast cancer and the breast clinical abnormalities (none, mass, skin abnormality, oedema, pain, nipple discharge, lymph nodes…) For each abnormality, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. ResultAmong the 3218 included patients (mean age 55.1 +/-10 years), 713 (22.2%) had an abnormal CBE and 133 (4.1%) had high-risk mammography. The sensitivity of CBE was 36%[28%;45%] and the specificity was 78%[77%;80%]. The PPV and NPV for each clinical abnormality were low, except for nipple discharge, retraction and lymph nodes, for which the PPV were 10.5[3.7;29.9], 6.6[1.4;31.6], and 5.0[1.5;17.1], respectively, but these abnormalities were rare (0.5%, 0.2% and 0.5% respectively). These values were similar across all age groups. ConclusionThe accuracy of CBE for breast cancer screening appeared to be low which did not support recommending regular CBE in France.

Breast and cervical cancer-screening uptake among females in Ardabil, northwest Iran: a community-based study.

PurposeBreast and cervical cancers are the most commonly diagnosed type of cancer and cause of cancer-related deaths in Iranian females. In contrast to previous studies, this study was carried out with a large sample size for assessment of breast self-examination (BSE)-, clinical breast examination (CBE)-, mammography-, and Pap smear-uptake rates and determination of associations among these screening behaviors with sociodemographic and cognitive variables in Azeri females.Materials and methodsThis was a cross-sectional, community-based study that was carried out among 1,134 females 20–60 years old during March–June 2016. Data-collection variables included sociodemographic questions, screening behaviors for breast and cervical cancer, self-efficacy, beliefs, and barriers to breast and cervical cancer screening. Collected data were analyzed by SPSS version 13 using χ2, Mann–Whitney U, and logistic regression tests.ResultsAmong the 1,134 participants, 53.9%, 9.8%, and 28.1% had done BSE, CBE, and Pap smear tests, respectively, and among the 625 females aged >40 years, 187 (29.9%) had done the mammography test. Moreover, 416 (36.7%), 103 (16.5%), and 64 (5.6%) females had done BSE, mammography, and CBE regularly, respectively. Beliefs, barriers, income, health insurance, number of children, and age were all important factors for BSE and regular BSE and mammography. Females who had high belief scores were more likely to undertake mammography (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.03–1.5), regular mammography (OR: 4.2, 95% CI: 1.9–9.3), regular CBE (OR: 1.25, 95% CI: 1.2–1.3), and Pap smears (OR: 1.2, 95% CI: 1.1–1.4). Also, females who had high self-efficacy scores were more likely to perform regular BSE (OR: 1.8, 95% CI: 1.4–2.5) and mammography (OR: 2.5, 95% CI: 1.4–4.6) than females with lower self-efficacy scores.ConclusionThe frequency of breast and cervical cancer screening was low in our study. The findings of this study indicated that beliefs, self-efficacy, and barriers were important predictive factors of cancer-screening behavior among the females studied.

Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers.

PurposeIn low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria.Materials and MethodsA cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire.ResultsA total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate.ConclusionThe majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

Pathological profile of patients with breast diseases in Shiraz.

Around 200,000 breast disorders are annually diagnosed all over the world. Fibrocystic changes are the most common breast disorder and fibroadenoma is the most prevalent benign breast tumor. The present study aimed to determine the spectrum, type and prevalence of breast masses in women referred to Shiraz University of Medical Sciences between 2004 and 2012 . A cross-sectional study was conducted on the diagnostic reports data. A total of 640 samples were studied. Most 57.3% of masses were detected in the left breast, 65%, 28.2% and 6.1% of cases presenting with benign, malignant, and inflammatory lesions, respectively. Among all the samples the most prevalent diagnosis (37.7%) was fibroadenoma and fibrocystic lesions (17%). 174 samples (96% of the malignant cases) were invasive. 6.5% of the benign, and 37% of the malignant cases occurred in post menopause women and the differences were statistically significant. Among those with malignant tumors lymph nodes were involved in 25.6% of menopausal women and 44.2% of non-menopausal ones, and the difference was statistically significant. Regular clinical breast examination beside mammographic follow-ups, especially during menopause, should be carried out as a priority and a national organized program should be designed for screening breast disorders.

Breast Cancer Knowledge, Beliefs, and Screening Practices among Women Seeking Care at District Hospitals in Dar es Salaam, Tanzania.

BACKGROUNDLimited disease awareness among women may impact breast cancer stage-at-diagnosis in Tanzania, reducing survival. This study assessed breast cancer knowledge, screening practices, and educational preferences among outpatients at Tanzanian government-supported hospitals.METHODSA convenience sample of women was surveyed regarding (1) knowledge/beliefs of breast cancer etiology, risk factors, symptoms, treatment, (2) early detection knowledge/practice, and (3) educational preferences.RESULTSAmong 225 respondents, 98.2% knew of breast cancer; 22.2% knew someone affected by breast cancer. On average, 30% of risk factors and 51% of symptoms were identified. Most accepted one or more breast cancer myths. Among 126 aware of breast self-exam, 40% did not practice it; only 0.9% underwent regular clinical breast examinations despite 68% being aware of the procedure. Among treatments, 87% recognized surgery, 70% radiation, and fewer systemic therapy. Preferred educational sources were group sessions, television/radio, and meetings with breast cancer survivors.CONCLUSIONSThis work reveals incomplete breast cancer awareness among Tanzanian women and promises to inform development of user-focused educational resources.

Experience of cohort studies in Trivandrum

This is the results of Trivandrum Oral Cancer Screening study (TOCS) initiated in 1996 and the Trivandrum Breast Cancer Screening study (TBCS) initiated in 2006. The objective of TOC study is to evaluate the efficacy of oral cancer screening by visual inspection of the oral cavity in detecting early stages of oral cancer and in reducing mortality. Control and intervention groups have been followed up for over 16 years. Visual screening for oral cancer was found to have acceptable sensitivity and specificity, associated with detection in early stages, associated with 34% reduction in oral cancer mortality, highly cost-effective and can be readily integrated into routine care. The TBCS study had the objective of evaluating the efficacy of breast cancer screening to reduce incidence of advanced breast cancer, increase survival and reduce mortality due to breast cancer. The intervention group received health education, regular clinical breast examination and early access to diagnostic procedures. Early stage cases, node negative cases and those who underwent conservative surgery were more among the intervention group.

Nonpalpable Breast Carcinomas: Long-Term Evaluation of 1,258 Cases

In recent decades, a steady improvement in imaging diagnostics has been observed together with a rising adherence to regular clinical breast examinations. As a result, the detection of small clinically occult (nonpalpable) lesions has progressively increased. At present in our institution some 20% of the cases are treated when nonpalpable. The aim of the present study is to analyze the characteristics and prognosis of such tumors treated in a single institution. The analysis focused on 1,258 women who presented at the European Institute of Oncology with a primary clinically occult carcinoma between 2000 and 2006. All patients underwent radioguided occult lesion localization (ROLL), axillary dissection when appropriate, whole breast radiotherapy, or partial breast intraoperative irradiation and received tailored adjuvant systemic treatment. Median age was 56 years. Imaging showed a breast nodule in half of the cases and a breast nodule accompanied by microcalcifications in 9%. Microcalcifications alone were present in 17.1% of the cases, whereas suspicious opacity, distortion, or thickening represented the remaining 24.6%. Most tumors were characterized by low proliferative rates (68.9%), positive estrogen receptors (92.3%), and non-overexpressed Her2/neu (91.3%). After a median follow-up of 60 months, we observed 19 local events (1.5%), 12 regional events (1%), and 20 distant metastases (1.6%). Five-year overall survival was 98.6%. Clinically occult (nonpalpable) carcinomas show very favorable prognostic features and high survival rates, showing the important role of modern imaging techniques.

Comparison of breast cancer survival in two populations: Ardabil, Iran and British Columbia, Canada

BackgroundPatterns in survival can provide information about the burden and severity of cancer, help uncover gaps in systemic policy and program delivery, and support the planning of enhanced cancer control systems. The aim of this paper is to describe the one-year survival rates for breast cancer in two populations using population-based cancer registries: Ardabil, Iran, and British Columbia (BC), Canada.MethodsAll newly diagnosed cases of female breast cancer were identified in the Ardabil cancer registry from 2003 to 2005 and the BC cancer registry for 2003. The International Classification of Disease for Oncology (ICDO) was used for coding cancer morphology and topography. Survival time was determined from cancer diagnosis to death. Age-specific one-year survival rates, relative survival rates and weighted standard errors were calculated using life-tables for each country.ResultsBreast cancer patients in BC had greater one-year survival rates than patients in Ardabil overall and for each age group under 60.ConclusionThese findings support the need for breast cancer screening programs (including regular clinical breast examinations and mammography), public education and awareness regarding early detection of breast cancer, and education of health care providers.

Impact of mammographic interval on stage and survival after the diagnosis of contralateral breast cancer.

Following treatment for primary breast cancer, annual mammography and regular clinical breast examination is advised. The aim of this study was to investigate whether annual mammography resulted in an improvement in stage of contralateral breast cancers compared with mammography performed at a longer interval. This was a retrospective analysis of patients treated for breast cancer, who developed a contralateral breast cancer between 1977 and 1998. Patients were stratified into two groups according to mammographic interval. Data were available for 275 patients who developed contralateral breast cancer during follow-up. Annual mammography was performed in 51 per cent; these patients were a mean of 5 years younger at diagnosis. Patients who had annual or biennial mammography had comparable rates of impalpable contralateral breast cancer, 30 and 27 per cent respectively. The tumours were of favourable stages in 60 and 58 per cent respectively. Five-year disease-free survival following diagnosis of contralateral breast cancer was 75 per cent in both groups. When the contralateral lesion was detected by mammography, disease-free survival was better, irrespective of the stage of the ipsilateral breast cancer. No difference was found between the two groups in stage distribution and disease-free survival after the diagnosis of contralateral breast cancer. Survival was better in patients in whom the contralateral breast cancer was first detected by mammography.

Clinical breast examination in primary care: perceptions and predictors among three specialties.

To assess predictors of reported performance of screening clinical breast examination (CBE) by internists, family physicians, and obstetrician/gynecologists, we surveyed members of these specialties in four counties of Washington State. We contacted all physicians in the counties and identified 334 providers who saw women ages 50-75 and provided primary care as their principal activity. Seventy-five percent (252 of 334) responded. Physicians were mailed a survey and contacted for telephone completion if they did not respond in writing. The survey inquired about their current performance of CBE and factors that might predispose, enable, or reinforce its use. Differences across specialties were assessed using the chi-square statistic. Factors associated with reported performance of screening CBE in > or =90% of women were evaluated using logistic regression. Fifty-one percent of physicians reported that they perform regular CBE on > or =90% of their patients, although the proportion varied across specialty type. Beliefs about the benefit of CBE were positive and similar across specialties. Twelve percent of male physicians, but no female physicians, reported that women's embarrassment affected their use of screening CBE. In a multivariate model, male gender, family practice specialty, and the perception of patient embarrassment were all associated with lower reported rates of performing regular CBE (p < 0.05). Work to increase the performance of CBE should consider the role of male physician embarrassment and family physician training. Ways to facilitate delivery of preventive care and factors influencing the women themselves may also be important to increased use of CBE.

Does the evidence justify national funding of breast cancer family history clinics?

Over the last 10 years efforts to prevent the morbidity, mortality and cost to society of breast cancer have concentrated on detecting early impalpable cancer and carcinoma in situ. Breast screening by mammography for women aged Xl-64 years reduces the number of symptomatic cancers and reduces mortality from this disease.’ Unfortunately, mammography is far from the perfect screening tool; at best reducing mortality in the over 50 year age group by 20-30%.’ For the majority of younger women, overall life expectancy from breast cancer has changed little over the last 50 years3 Increased understanding of the aetiology of breast cancer combined with enhanced ability to perform genetic screening has enabled a more accurate assessment of those at significant increased risk of developing the disease. For these women considered to be at high risk, many breast units have introduced ‘Family History Clinics’. For these clinics to be beneficial, they must ultimately lead to a reduction in the mortality from breast cancer. Women who attend family history clinics undergo a primary assessment during which lifetime risk for breast cancer development is calculated based on a detailed family history with or without genetic screening. Following assessment of risk, women are advised about correct examination techniques, and may then be enrolled into a screening programme consisting of regular clinical breast examination and annual mammography. Women considered to be at very high risk are considered for prophylactic surgery by either simple or subcutaneous mastectomy. Are such interventions justified?

Health risk factors and health promoting behavior of medical, dental and nursing students

The assumption of this study is: the preventive care beliefs and practices of health science students stand-out among the general public. To test this assumption, a survey of beliefs, behaviors and disease prevention practices of medical, dental, undergraduate and graduate nursing students in three health science schools was carried out in New Jersey. All students in these three schools were included in the study. A questionnaire which consisted of information on socio-demographic, life style patterns, health risk factors, and preventive cares was used. Results showed that 99% of the students knew their blood pressure, 10% were cigarette smokers and 3% were heavy drinkers. Approximately 68% of the students exercised regularly and 78% of them used seat belts. About 81 and 79% of the female students had regular clinical breast examinations (CBE) and pelvic examinations, respectively. It is worth noting that 10% of medical and dental students had driven an automobile under the influence of alcohol. About 77% of all students did not know their cholesterol levels, and 14% of dental students reported no concern about fat consumption. Only 38% of the female students reported monthly breast self examination (BSE). Over 27% of undergraduate nursing and 14% of all students never had a Papanicolaou (Pap) test. The main reasons for never having a Pap test, CBE, and pelvic examinations were: they did not, think it was necessary and they believed that they were not at risk. The major reason for not performing BSE was forgetfulness. These findings confirmed the assumptions that preventive care beliefs and practices of health science students stand-out among the general public. These findings rejected the common belief model “do as I say, not as I do” regarding these health science students.

Psychological Distress and Surveillance Behaviors of Women With a Family History of Breast Cancer

Women with a family history of breast cancer are at increased risk for developing the disease. This study investigated the beliefs of women at high risk for breast cancer (one or more first-degree relatives with breast cancer) about their breast cancer risk and the impact of this information on their surveillance behaviors and psychological distress. The Health Belief Model and the Fear Arousing Communications Theory were used in this study. Two hundred and seventeen women, enrolled in a breast protection program, completed a questionnaire regarding health beliefs and behaviors, social support, and psychological distress. While 94% came in for regularly scheduled mammograms, only 69% came in for regular clinical breast examinations. A discriminant function analysis revealed that increased cancer anxiety decreased regular clinical examinations (coefficient = -.65). Only 40% performed breast self-examination monthly, 10% never performed breast self-examination, and 50% did not perform breast self-examination regularly. High breast self-examination performance prior to coming to the program was the best predictor of current breast self-examination, and high anxiety predicted poor adherence to monthly breast self-examination (multiple R = .61). More than 27% of the women at high risk were defined as having a level of psychological distress consistent with the need for counseling. Women reporting more barriers to screening, fewer social supports, and low social desirability had more psychological distress (multiple R = .75). Higher anxiety was directly related to poor attendance at a clinical breast examination and poor adherence to monthly breast self-examination.(ABSTRACT TRUNCATED AT 250 WORDS)